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Utilization patterns and determinants of postpartum contraceptive methods: A cross-sectional study
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Received: ,
Accepted: ,
How to cite this article: Chauhan S, Naik DB, Kesari P. Utilization patterns and determinants of postpartum contraceptive methods: A cross-sectional study. J Reprod Healthc Med. 2026;7:6. doi: 10.25259/JRHM_3_2026
Abstract
Objectives:
Postpartum family planning is a cornerstone of maternal health, but the adoption of reversible contraceptive methods remains low in India. This study evaluates the distribution and predictors of postpartum contraceptive utilization among women at an Urban Health Training Center (UHTC), Bidar, Karnataka, India, with the objectives to determine the distribution and frequency of postpartum contraceptive methods among women delivering at UHTC, Bidar, and to analyze the association between delivery mode and contraceptive choice.
Materials and Methods:
A prospective cross-sectional study enrolled 159 postpartum women from June to September, 2025. Data were collected on demographics, delivery details, and contraceptive choices within 6 weeks post-delivery. Analyses included descriptive statistics, contingency tables, and Chi-square test to check association using Jamovi 2.6.44 software.
Results:
Most women (79.2%) opted for implants; 18.9% underwent tubectomy. Very few chose intrauterine devices or oral pills (0.6% each), with only one participant opting for no method. Cesarean delivery predominated (93.7%) and showed a significantly drastic (P < 0.001) association with implant and tubectomy. Other demographic factors were not significant predictors of contraceptive use.
Conclusion:
Mode of delivery, particularly cesarean section, and immediate counselling decisively influence postpartum contraceptive choices, while individual sociodemographic factors have limited impact. More focus is required on enhanced counselling to improve the adoption of reversible methods.
Keywords
Cesarean section
Contraceptive implants
Family planning services
Postpartum contraceptive methods
Postpartum period
INTRODUCTION
Postpartum family planning (PPFP) is crucial for maternal and child health, helping prevent unintended pregnancies and ensuring optimal birth spacing, thereby reducing associated risks. However, in India, postpartum contraceptive uptake remains low; only about 59% of women use any method within the 1st year after delivery.[1] Sterilization dominates especially in rural and semi-urban areas, while reversible methods are underutilized.[2] Multiple factors, including educational status, parity, socioeconomic background, delivery mode, and newborn sex, shape contraceptive choices.[3] This study at the Urban Health Training Center (UHTC), Bidar, Karnataka, India, provides insights to enhance PPFP services.
Despite regular contact during antenatal, delivery, and postnatal care at our UHTC, Bidar, many women leave without contraception, missing vital opportunities for family planning. Nationally, only 23% of postpartum women adopt contraceptives within 6 months, hindered by cultural barriers, lack of awareness, and systemic challenges. Patient counseling gaps, family pressures, misconceptions, and son preference further complicate adoption.[3] Addressing these factors is essential to empowering women to make informed choices.
This study thus serves as a timely assessment to identify contraceptive use patterns and influencing factors, guiding improvements in service delivery and community education at UHTC, Bidar.
MATERIALS AND METHODS
Study design and setting
This prospective cross-sectional study was conducted at UHTC, Bidar, from June to September, 2025. All women delivering during this period, who provided informed consent, were enrolled consecutively. The data collection included review of delivery registers, family planning records, and sterilization logs to ensure coverage of all eligible women.
Data collection
Information was obtained on maternal sociodemographic characteristics (age, residence, education, occupation, socioeconomic status), delivery details (mode of delivery and complications), newborn characteristics (sex and birth weight), and the use of postpartum contraceptive methods within 6 weeks after delivery. Women with incomplete records or who refused consent were excluded.
Definitions
Postpartum period: The period up to 6 weeks (42 days) after delivery[4]
Postpartum contraceptive methods: Any temporary or permanent method adopted in the first 6 weeks, including intrauterine contraceptive devices (IUCDs), oral contraceptive pills (OCPs), injectables, condoms, and sterilization.[4]
Statistical analysis
Categorical and continuous variables were summarized using frequency, percentages, mean, and standard deviation. Associations between delivery mode or newborn sex and contraception method were tested using the Chi-square test. Analysis was performed using Jamovi version 2.6.44.[5] The ρ < 0.05 is considered statistically significant.
RESULTS
Participant demographics
A total of 159 postpartum women were included in the study. The mean age of participants was 25.2 ± 3.71 years, with a median of 25 years and a range from 19 to 39 years. Most women had parity between one and two, with a mean parity of 1.77 ± 0.93. The average birth weight of newborns was 2.84 ± 0.42 kg, with a median of 2.80 kg and a range from 1.9 to 4.0 kg [Table 1]. In terms of religious composition, 52.2% of women were Hindu, 42.8% were Muslim, and 5% were Christian [Table 2].
| Variable | Mean±SD | Median | Range |
|---|---|---|---|
| Age (years) | 25.2±3.71 | 25 | 19.0–39.0 |
| Parity | 1.77±0.93 | 2 | 1.0–6.0 |
| Birth weight (kg) | 2.84±0.42 | 2.80 | 1.9–4.0 |
SD: Standard deviation
| Factor | Category | Frequency | Percentage |
|---|---|---|---|
| Religion | Hindu | 83 | 52.2 |
| Muslim | 68 | 42.8 | |
| Christian | 8 | 5.0 | |
| Mode of delivery | Normal vaginal delivery (FTND) | 9 | 5.7 |
| Cesarean (LSCS) | 149 | 93.7 | |
| Assisted | 1 | 0.6 | |
| Sex of newborn | Female | 86 | 54.1 |
| Male | 73 | 45.9 |
FTND: Full-term normal delivery, LSCS: Lower segment cesarean section
Regarding delivery characteristics, lower segment cesarean section (LSCS) was the predominant mode of delivery, accounting for 93.7% of cases, while normal vaginal delivery (full term normal delivery [FTND]) occurred in 5.7% and assisted delivery in only 0.6%. Among the newborns, 54.1% were female, and 45.9% were male [Table 2].
Contraceptive method uptake
The most commonly adopted postpartum contraceptive method was implant insertion, chosen by 79.2% of women. Tubectomy was the second most frequent method, reported by 18.9% of participants. In contrast, IUCDs and OCPs were each used by only 0.6%, and one woman reported using no method at all [Table 3].
| Method | Frequency | Percentage |
|---|---|---|
| Implant | 126 | 79.2 |
| Tubectomy | 30 | 18.9 |
| IUCD | 1 | 0.6 |
| Oral pills | 1 | 0.6 |
| None | 1 | 0.6 |
IUCD: Intrauterine contraceptive device, UHTC: Urban Health Training Center
A significantly drastic (p < 0.001) association was observed between mode of delivery and choice of contraceptive method. Women undergoing cesarean section overwhelmingly opted for implants or tubectomy, likely due to increased counseling opportunities during the perioperative period. In contrast, women with FTND showed more varied but fewer choices, including IUCDs and oral pills [Table 4].
| Delivery mode | None | Implant | Tubectomy | IUCDs | OCPs | Total (%) |
|---|---|---|---|---|---|---|
| Normal (FTND) | 0 | 7 | 0 | 1 | 1 | 9 |
| Cesarean (LSCS) | 1 | 118 | 30 | 0 | 0 | 149 |
| Assisted | 0 | 1 | 0 | 0 | 0 | 1 |
| Total | 1 | 126 | 30 | 1 | 1 | 159 |
Chi-square=35.5, p<0.001, df=8. FTND: Full-term normal delivery, LSCS: Lower segment cesarean section, IUCDs: Intrauterine contraceptive devices, OCPs: Oral contraceptive pills
Association with newborn’s sex
The sex of the newborn did not significantly (p = 0.596) influence contraceptive choice. Among mothers of female infants, 76.7% chose implants and 19.8% opted for tubectomy, while among mothers of male infants, 82.2% chose implants and 17.8% opted for tubectomy. The distribution of IUCDs and OCPs use was negligible in both groups [Table 5].
| Sex | None (%) | Implant (%) | Tubectomy (%) | IUCDs (%) | OCPs (%) | Total |
|---|---|---|---|---|---|---|
| Female | 1 (1.2) | 66 (76.7) | 17 (19.8) | 1 (1.2) | 1 (1.2) | 86 |
| Male | 0 (0.0) | 60 (82.2) | 13 (17.8) | 0 (0.0) | 0 (0.0) | 73 |
| Total | 1 (0.6) | 126 (79.2) | 30 (18.9) | 1 (0.6) | 1 (0.6) | 159 |
IUCDs: Intrauterine contraceptive devices, OCPs: Oral contraceptive pills
DISCUSSION
The present study highlighted a very high acceptance of long-acting reversible contraception, notably implants, among postpartum women at UHTC, Bidar, with 79.2% opting for implants and 18.9% for tubectomy within 6 weeks after delivery. The adoption rate for other reversible methods, such as IUCDs and OCPs, was extremely low (0.6% each), and only a single woman reported using no postpartum method. The high rate of LSCS (93.7%) significantly influenced this pattern, with the majority of cesarean-delivered women choosing either an implant or tubectomy. A strong, statistically significant association was found between mode of delivery and the contraceptive method adopted (p < 0.001), whereas no such association was seen with sociodemographic factors or the sex of the newborn.
These findings align with national and regional literature but also present some unique contrasts. The dominance of implants and tubectomy is comparable to the national reliance on permanent and long-acting methods. For instance, Johns et al.[1] (National Family Health Survey [NFHS]-5 analysis) observed a 59.2% national uptake of postpartum contraceptives, with sterilization and condoms being most common; implants were less frequently reported in national datasets, suggesting that local practices, institutional protocols, or targeted counseling at UHTC may influence preferences.[1] The higher uptake of reversible implants versus permanent methods seen in this study, particularly in an urban semi-referral setting, diverges from the national norm, where sterilization dominates in both rural and many urban regions.[1,2]
Although implant acceptance was high in our cohort, the literature notes common side effects such as irregular bleeding, headache, and weight changes. Continuation rates remain favorable, with studies reporting >80% retention at 1 year. However, availability and affordability in rural areas remain challenges; government pilot programs in Karnataka have improved supply, but equitable access for rural mothers requires sustained investment and an awareness campaign.[6,7]
Compared to studies in North and West India, such as Pal et al.[8] and Farogh and Palve,[9] the postpartum implant uptake in Bidar is remarkably high. In the North Indian study, 89% of women opted for any contraceptive following structured counseling, but preferences were split between spacing and permanent methods, with injectables and condoms being popular choices.[8,9] In Mumbai’s urban tertiary setting, most chosen methods were condoms, postpartum intrauterine contraceptive device (PPIUCD), tubectomy, and injectables, and acceptance was strongly correlated with multiparity, maternal education, and counseling exposure.[9] The present study also noted high rates of implant use but limited diversity in method mix, likely reflecting both supply factors (hospital availability) and the intensive counselling received during cesarean admissions. The unusually high uptake of implants in our study may also reflect institutional protocols and the ongoing pilot program in Karnataka, which introduced subdermal implants in Bidar and Bengaluru, and subcutaneous injectables in Mysuru and Yadgir. This initiative, launched in 2023 by the State Health Department, aimed to expand contraceptive choices and may have influenced local availability and counselling practices.[10]
IUCD utilization in this study (0.6%) was much lower than reported from other tertiary hospitals and community-based interventions. Kumar et al.[11] documented a 60% acceptance rate for PPIUCDs after delivery among women with higher education and good antenatal counselling in Uttar Pradesh, India,[11] while Sebastian et al. showed a 57% modern method adoption at 9 months postpartum in rural Uttar Pradesh, with PPIUCD and condoms being the most frequent choices following community health worker interventions.[12] The low IUCD acceptance in the present study may result from misconceptions, lack of demand generation, low provider promotion, or logistic constraints; moreover, the ongoing pilot program in Karnataka (introducing subdermal implants in Bidar and Bengaluru, and subcutaneous injectables in Mysuru and Yadgir since 2023) aimed to expand contraceptive choices, which may have shifted local availability and counselling practices away from IUCDs, thereby influencing uptake.[10]
Johns et al.,[1] using NFHS5 data, and Srivastava[13] both found that education, urban residence, and parity significantly predicted early or temporary contraceptive method uptake at the national level,[1,13] while this effect was not significant in the Bidar sample after accounting for delivery mode, emphasizing the overwhelming influence of in-hospital, perioperative contraceptive counselling.
Depot medroxyprogesterone acetate (DMPA) injectables and Centchroman (Chhaya), the nonhormonal weekly pill, were not reported in our sample. According to the Ministry of Health and Family Welfare, India’s national program includes DMPA injectables and Centchroman (Chhaya) as part of the contraceptive basket, yet their use remains limited. Women often face barriers such as inconsistent availability, lack of awareness, and hesitation among providers to recommend them. Bringing these contraceptives into routine postpartum counseling could give mothers more real choices, especially those who prefer spacing methods, and help reduce the current reliance on implants and sterilization.[14]
This study also confirms earlier evidence that intensive counselling at the time of delivery, especially during or after cesarean section, is decisive for acceptance of spacing and permanent methods.[15] Structured, immediate counselling interventions, as found in Mumbai and in North Indian hospitals, can double contraceptive initiation rates.[8,9] Even though IUCDs and pills are available, women often do not use them. Kapp and Curtis[16] found postpartum IUCDs are safe but often expelled if inserted right after birth,[16] while Grimes et al.[17] stressed that better counseling and followup are needed to make postpartum IUCD programs work.[17]Our findings echo these gaps, pointing to the same mix of service delivery and communication issues that limit real choice.
Limitations
The single-center setting and relatively modest sample size may reduce the generalizability and limit the analysis of predictors beyond delivery mode. The disproportionately high cesarean rate hampers comparison with national averages, and institutional policy influence warrants further study.
Our study assessed contraceptive choice within 6 weeks postpartum, but did not evaluate continuation beyond this period. A longer follow-up is essential to understand adherence, side-effects, and method switching, particularly for reversible methods such as implants, IUCDs, and OCPs.
CONCLUSION
Mode of delivery (especially LSCS) and immediate postpartum counselling are strong determinants of contraceptive choice in the postpartum period. Sociodemographic variables appear less influential. Integrating structured counselling at every delivery, especially cesarean, and addressing persistent gaps in awareness and access to reversible methods remain critical for optimizing maternal health outcomes.
Acknowledgment:
The authors would like to thank the staff of the Urban Health Training Centre, Bidar, for their support during data collection and the faculty of the Department of Community Medicine, Bidar Institute of Medical Sciences, for their guidance. We are grateful to the participating mothers for their cooperation.
Recommendations:
It is strongly recommended to enhance structured counselling on all postpartum methods, especially reversible options, and utilize the immediate post-cesarean period for effective education and method provision, employing community-based interventions and ASHA collaboration to address misconceptions and improve uptake. There should be broader future research to include a larger, more diverse population and consider qualitative approaches to understand cultural and institutional barriers. The future studies should assess continuation rates and expand counselling to include DMPA and Chhaya.
Ethical approval:
The research/study was approved by the Institutional Review Board at Bidar Institute of Medical Sciences, number 287/BRIMS/IEC/2025, dated June 12, 2025.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for clinical information to be reported in the journal. The patient understands that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was use of artificial intelligence (AI). Generative AI tools were used only to assist with language refinement and grammar correction during manuscript preparation. No AI tools were used in study design, data collection, analysis, or interpretation. The authors take full responsibility for the scientific content of this article.
Financial support and sponsorship: Nil.
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